title: Comparison of renal ischemic damage during laparoscopic partial nephrectomy with artery-vein and artery-only clamping.
abstract: OBJECTIVE
  To compare renal ischemic damage caused by artery-only (AO) and artery-vein (AV) clamping after laparoscopic partial nephrectomy.
  
  
  METHODS
  We included 58 patients who underwent laparoscopic partial nephrectomy for nonhilar exophytic renal tumors in this study. AV clamping was used for 26 of these patients, while AO clamping was used for 32. All patients had a functional contralateral kidney. We assessed effective renal plasma flow (ERPF) by (99m)Technetium-mercaptoacetyltriglycine ((99m)Tc-MAG3) renal scintigraphy preoperatively and at 1 week and 6 months postoperatively. In addition, we analyzed (99m)Tc-MAG3 uptake regionally in the surgically nonaffected areas.
  
  
  RESULTS
  Mean tumor diameters were 3.0 cm in the AV group and 2.8 cm in the AO group. Warm ischemic time was significantly shorter in the AV group than the AO group (26.3 vs. 30.7 minutes, respectively, p=0.007). There were no differences in the estimated glomerular filtration rates or ERPF of the operated kidney between groups preoperatively or 1 week or 6 months postoperatively. The decrease in regional (99m)Tc-MAG3 uptake of the operated kidney at 1 week was correlated with warm ischemic time in both groups, being stronger in the AV group (p<0.001) than in the AO group (p=0.027). This decrease was significantly less in the AO group when the ischemic time was ≥25 minutes (88.1% vs. 102.5%, p=0.001).
  
  
  CONCLUSIONS
  Ischemic renal damage during laparoscopic partial nephrectomy was lessened by applying AO clamping particularly in cases with prolonged ischemic time.
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine , Nagoya, Japan .
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Funahashi
authors.forename: Masashi
authors.initials: M
authors.lastname: Kato
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshino
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujita
authors.forename: Naoto
authors.initials: N
authors.lastname: Sassa
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003250:Constriction; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply* / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*; D012082:Renal Veins / Q000601:surgery*; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects